Obesity and chronic kidney disease (CKD) are major public health problems. Obesity independent of its relationship with diabetes and hypertension is associated with the development and progression of kidney disease. However, higher body mass index (BMI) in those with pre-existing CKD is associated with lower mortality (obesity paradox). Ths may be due to the inability of BMI to differentiate fat mass and muscle mass, which may have opposite relationship with cardiovascular disease and death. Body fat distribution is a major facto that determines the metabolic health with visceral adiposity correlating better with metabolic abnormaliies than the subcutaneous adipose tissue. Further, higher fitness level among those with higher BMI is associated with lower prevalence of cardiovascular risk factors and mortality that might explain ths obesity paradox. Therefore, in this study, we propose to examine whether visceral adiposity (as measured by magnetic resonance imaging of abdomen) and physical fitness (as measured by 400 m walk test) are associated with higher incidence of composite outcomes (a composite of mortality, cardiovascular events, end stage renal disease and 50 percent decline in estimated glomerular filtration rate) among participants who are recruited to the phase Ill of the Chronic Renal Insuffiiency Cohort (CRIC) study. In addition, we will also study whether visceral adiposity and physical fitnes are associated with altered adipokine profile, inflammation, insulin resistance, and oxidative stress aong CRIC participants. These would also help us understand the influence of physical fitness on cardiovascular disease and kidney disease progression among kidney disease patients with varying degrees of visceral adiposity. This study results would also provide Insights into the mechanisms tat underpin these relationships thereby providing an opportunity to develop interventions targeting thse cardiovascular and renal risk factors that are relevant in this population.